February 04, 2018

In an important article in the NY Times this week, journalist Paula
Span points out the dire consequences to the nursing home industry if the Trump
administration ends “temporary protective status” for refugees from countries
such as Haiti and El Salvador. These countries are where many of the poorly
paid, hard-working, desperately needed aides who care for nursing home
residents come from, especially in certain states including New York,
California, and Florida.

But there’s even more at stake in
the immigration debate than the devastating but short-term problem relating to
temporary protective status. Trump is promoting what he calls “merit-based”
immigration: determining who can move to the U.S. with the hope of ultimately
becoming a citizen based on what they will “contribute” to American society.
That’s not necessarily a bad idea—although it’s important to preserve the
distinction between refugees and immigrants, where refugees see the U.S as a
haven from the discrimination and persecution that they face in their home
countries, and immigrants see the U.S. as a land of economic opportunity as
well as political freedom. But if we are going to accept immigrants based on
their potential benefit to American society, who will decide what counts as a
benefit?

The U.S. does not just need
brilliant scientists and engineers. And in fact, robbing other countries of
their elites may be destabilizing for those countries and not, in the long run,
beneficial to the U.S. The U.S. needs unskilled workers such as nursing assistants—people
who are in short supply at present and the need for whom will soar in the
coming years as the number of people over age 85 (the group in greatest need of
personal care) triples.This past year, 45,000 nursing assistant job openings
went unfilled. These are not jobs that Americans are clamoring for: the pay is
poor (the median wage in 2016 was $12.34 n hour), injury rates are high, and
opportunities for advancement are meager.

If standard economic models
were applicable to this situation, we would expect wages to rise, attracting
more workers. But nursing home revenue is determined in large measure by how
much state legislatures allow Medicaid to pay nursing homes, and financially
strapped states are not increasing their Medicaid budgets. As a result, nursing
homes will compromise patient care or close before they increase wages.

Who does take a job as an aide
in a nursing home?

The 600,000 people who take care of some of the oldest, most
vulnerable members of our society are largely black women; 20 percent of them
were born outside the U.S.

If immigration reform means entry
to the U.S. will be based on who has the most to give, we better make sure that
poorly educated but caring and conscientious women are our priority.